Provider Demographics
NPI:1396119186
Name:WALDROP, REBECCA GOLDEN (MED, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:GOLDEN
Last Name:WALDROP
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7662
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-7662
Mailing Address - Country:US
Mailing Address - Phone:478-455-1171
Mailing Address - Fax:
Practice Address - Street 1:117 3RD ST E
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794
Practice Address - Country:US
Practice Address - Phone:478-455-1171
Practice Address - Fax:229-329-4532
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008926235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14058959OtherAMERICAN SPEECH LANGUAGE HEARING ASSOCIATION